scholarly journals SEQUENTIAL IMPLEMENTATION AS A LEARNING HEALTH ORGANIZATION: THE EQUIPPED GERIATRIC MEDICATION SAFETY MODEL

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S945-S945
Author(s):  
Ann E Vandenberg ◽  
Michelle Kegler ◽  
Susan Hastings ◽  
Ula Hwang ◽  
Camille Vaughan
Keyword(s):  
Older Adults ◽  
Structural Characteristics ◽  
Scale Up ◽  
Lessons Learned ◽  
Research Network ◽  
Public Health Issue ◽  
Potentially Inappropriate Medications ◽  
Prescribing Practices ◽  
Intervention Package ◽  
Health Organization

Abstract A learning health organization (LHO) is one that systematically integrates internal data and experience with external evidence to improve internal healthcare practice. Yet collaborative research networks implementing evidence-based interventions across sites with the goal of widespread dissemination are also effectively LHOs. The EQUIPPED (Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department) network formed to address an important public health issue: potentially inappropriate medications (PIMs) prescribed to older adults at discharge from hospital Emergency Departments (ED). EDs nationwide serve increasing numbers of older adults but lack clinical decision support to avoid prescribing PIMs associated with adverse events including hospitalization and death. The EQUIPPED geriatric safety program was adapted from the VA and implemented sequentially at three different academic institutions sharing the same electronic health record (Epic)(AHRQ R18HS24499). Implementation challenges, solutions, and innovations informed successive iterations. Using the Replicating Effective Programs framework, we conducted a process evaluation using data from implementation team focus groups (n=3), meeting minutes (n=98 hours), and organizational profiles (n =3) to understand how organizations working together within a research network build an intervention package for program scale-up. We present structural characteristics of the three organizations, implementation steps as they developed across three sites, and the resulting process protocol and a prototype toolkit. Lessons learned include having multiple internal champions at the intervention site, observing workflow pre-intervention, and streamlining data collection with a relational database and visualization software. Insights from the EQUIPPED experience can serve as a model for other systems and collaborative networks.

scholarly journals Building on Lessons Learned in a Mobile Intervention to Reduce Pain and Improve Health (MORPH): Protocol for the MORPH-II Trial (Preprint)

2021 ◽  
Author(s):  
Jason Fanning ◽  
Amber K Brooks ◽  
Katherine L Hsieh ◽  
Kyle Kershner ◽  
Joy Furlipa ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Chronic Pain ◽  
Weight Loss ◽  
Pilot Study ◽  
Cognitive Theory ◽  
Lessons Learned ◽  
Control Group ◽  
Intervention Package ◽  
Improve Health

BACKGROUND Engaging in sufficient levels of physical activity, guarding against sustained sitting, and maintaining a healthy body weight represent important lifestyle strategies for managing older adults’ chronic pain. Our first Mobile Health Intervention to Reduce Pain and Improve Health (MORPH) randomized pilot study demonstrated that a partially remote group-mediated diet and daylong activity intervention (ie, a focus on moving often throughout the day) can lead to improved physical function, weight loss, less pain intensity, and fewer minutes of sedentary time. We also identified unique delivery challenges that limited the program’s scalability and potential efficacy. OBJECTIVE The purpose of the MORPH-II randomized pilot study is to refine the MORPH intervention package based on feedback from MORPH and evaluate the feasibility, acceptability, and preliminary efficacy of this revised package prior to conducting a larger clinical trial. METHODS The MORPH-II study is an iteration on MORPH designed to pilot a refined framework, enhance scalability through fully remote delivery, and increase uptake of the daylong movement protocol through revised education content and additional personalized remote coaching. Older, obese, and low-active adults with chronic multisite pain (n=30) will be randomly assigned to receive a 12-week remote group-mediated physical activity and dietary weight loss intervention followed by a 12-week maintenance period or a control condition. Those in the intervention condition will partake in weekly social cognitive theory–based group meetings via teleconference software plus one-on-one support calls on a tapered schedule. They will also engage with a tablet application paired with a wearable activity monitor and smart scale designed to provide ongoing social and behavioral support throughout the week. Those in the control group will receive only the self-monitoring tools. RESULTS Recruitment is ongoing as of January 2021. CONCLUSIONS Findings from MORPH-II will help guide other researchers working to intervene on sedentary behavior through frequent movement in older adults with chronic pain. CLINICALTRIAL ClinicalTrials.gov NCT04655001; https://clinicaltrials.gov/ct2/show/NCT04655001 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/29013

scholarly journals COVID-19 and Older Adults. Lessons Learned from the Italian Epicenter

2020 ◽  
Vol 23 (1) ◽  
pp. 155-159 ◽  
Author(s):  
Matteo Cesari ◽  
Manuel Montero-Odasso
Keyword(s):  
Older Adults ◽  
Mortality Rate ◽  
Clinical Presentation ◽  
Healthcare Resource ◽  
Lessons Learned ◽  
World Health ◽  
Severe Illness ◽  
Previous Diagnosis ◽  
Ventilation Support ◽  
Health Organization

On March 13th, 2020, The World Health Organization effectively established that Europe is the new the COVID-19 pandemic world epicenter, as cases in Italy and other European nations soared. The numbers in Italy have climbed with over 80,000 cases as of March 25th, 2020 and with over 8000 deaths, placing Italy now as the country with the highest mortality rate. Importantly, older adults are particularly vulnerable to get severe illness, complications, and to have a higher mortality rate than any other age group. The clinical presentation in older adults with severe illness, in the experience from geriatricians in Lombardy, is described as quite sudden; patients can develop severe hypoxemia with the need of ventilation support in few hours. Geriatric syndromes are not a common form of presentation for COVID-19 in severe illness. It is suggested that stratification by frailty level may help to detect the most vulnerable, and decisions about healthcare resource prioritization should not be taken based only on age itself or previous diagnosis, such as having dementia.

scholarly journals Sex Differences in Potentially Inappropriate Prescribing Among Older Adults With Multimorbidity

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 335-336
Author(s):  
Maria Ukhanova ◽  
Sheila Markwardt ◽  
Jon Furuno ◽  
Laura Davis ◽  
Brie Noble ◽  
...  
Keyword(s):  
Older Adults ◽  
Sex Differences ◽  
Inappropriate Prescribing ◽  
Secondary Analysis ◽  
Potentially Inappropriate Medications ◽  
Prescribing Practices ◽  
Chi Square ◽  
Physical Conditions ◽  
Disease Patterns ◽  
Drug Classes

Abstract Sex differences in prescribing potentially inappropriate medications (PIMs) for various multimorbidity patterns are not well understood. This study sought to identify sex specific risk of PIMs in older adults with cardiovascular-metabolic patterns. Secondary analysis of the Health and Retirement Study interview data (2004-2014; n=6,341, ≥65 y/o) linked to Medicare claims data was conducted. Four multimorbidity patterns were identified based on the list of 20 chronic conditions and included: ‘cardiovascular-metabolic only’, ‘cardiovascular-metabolic plus other physical conditions’, ‘cardiovascular-metabolic plus mental conditions’, and ‘no cardiovascular-metabolic disease’ patterns. Presence of PIM prescribing was identified using the 2015 American Geriatrics Society Beers Criteria, limited to the list of medications to avoid in older adults. Chi-square tests and logistic regressions were used to identify sex differences in prescribing PIMs across multimorbidity patterns: (1) for PIMs overall and (2) for each PIM drug class. Results indicate that on average women were prescribed PIMs more often than men (39.4% and 32.8%, respectively). Women with cardiovascular-metabolic plus other physical patterns (Adj.OR=1.25, 95% CI: 1.07-1.45) and cardiovascular-metabolic plus mental patterns (Adj.OR=1.25, 95% CI: 1.06-1.48) had higher odds of PIM compared to men, however, there were no sex differences in PIM prescribing in the cardiovascular-metabolic only patterns (Adj.OR=1.13, 95% CI: 0.79-1.62). There was variation by sex across different PIM drug classes. Our study emphasizes the need to further reduce PIM prescribing among older adults, and identifies target populations for potential interventions to improve medication prescribing practices.

scholarly journals Lessons learned from implementation of the Workload Indicator of Staffing Need (WISN) methodology: An international Delphi study of expert users.

2021 ◽  
Author(s):  
Grace Nyendwoha Namaganda ◽  
Audrey Whitright ◽  
Everd Bikaitwoha Maniple
Keyword(s):  
Delphi Study ◽  
Scale Up ◽  
Lessons Learned ◽  
World Health ◽  
Small Scale ◽  
Successful Implementation ◽  
Time Data ◽  
Implementation Challenges ◽  
Health Organization ◽  
First Time

Abstract BackgroundStaffing of health services ought to consider the workload experienced to maximize efficiency. However, this is rarely the case, due to lack of an appropriate approach. The World Health Organization (WHO) developed and has promoted the Workload Indicators of Staffing Need (WISN) methodology globally. Due to its relative simplicity compared to previous methods, the WISN has been used extensively, particularly after its computerization in 2010. Many lessons have been learnt from the introduction and promotion of the methodology across the globe but have, hitherto, not been synthesized for technical and policy consideration. This study gathered, synthesized, and now shares the key adaptations, innovations, and lessons learned. These could facilitate lesson-learning and motivate the WHO’s WISN Thematic Working Group to review and further ease its application.MethodsThe study aimed to answer four questions: (1) how easy is it for the users to implement each step of the WISN methodology? (2) what innovations have been used to overcome implementation challenges? (3) what lessons have been learned that could inform future WISN implementation? and (4) what recommendations can be made to improve the WISN methodology? We used a three-round traditional Delphi method to conduct a case study of user-experiences during the adoption of the WISN methodology. We sent three email iterations to 23 purposively selected WISN expert users across 21 countries in five continents. Thematic analysis of each round was done simultaneously with data collection.ResultsParticipants rated seven of the eight technical steps of the WISN as either “very easy” or “easy” to implement. The step considered most difficult was obtaining the Category Allowance Factors (CAF). Key lessons learned were that: the benefits gained from applying the WISN outweigh the challenges faced in understanding the technical steps; benchmarking during WISN implementation saves time; data quality is critical for successful implementation; and starting with small-scale projects sets the ground better for more effective scale-up than attempting massive national application of the methodology the first time round. ConclusionsThe study provides a good reference for easing WISN implementation for new users and for WHO to continue promoting and improving upon it.

Potentially Inappropriate Medications Use in A Population of Iraqi Geriatric Outpatients According to Beers Criteria

2019 ◽  
Vol 10 (02) ◽  
Author(s):  
Ola Albaghdadi ◽  
Salam , Mohammad Hassan Morteza, Firas A Ahjel ◽  
Mohammad Hassan Morteza ◽  
Firas Aziz Rahi
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Public Health Issue ◽  
Beers Criteria ◽  
Potentially Inappropriate Medications ◽  
Cross Sectional ◽  
Face To Face ◽  
Inappropriate Drugs ◽  
Elderly Outpatients ◽  
Inappropriate Medications

Aims: Elderly in Iraq kept suffering multiple burdens, as they are a truly fragile and vulnerable segment. A major public health issue among elderly is adverse drug reactions. This study is aimed at contributing in overcoming this treatment gap by determining the prevalence of inappropriate medications used by a group of Iraqi elderly outpatients. Methods: A cross-sectional, questionnaire-based study was conducted in a sample of 85 Iraqi elderly aged ≥65 years of either gender. Participants had face-to-face interviews to answer a comprehensive questionnaire. Each drug taken by the patient was evaluated according to Beers criteria. Results: Females constituted 45.9% of the total. The average age was 69.9 years (± 4.6). Nearly 30% of the patients had 3 different diseases, and 17.8% had ≥4 different ones, with cardiovascular diseases were the most prevalent. Polypharmacy was notably identified in 47.1% of the total studied population. Twenty-eight out of 85 patients did not know the actual reason of taking at least one of their medications, and 42% were not taking their drugs as directed. Remarkably, 43.5% of patients were recognized as taking at least one medication to be avoided in elderly people according to the Beers criteria. The most common inappropriate drugs were glyburide, and proton-pump inhibitors. Conclusion: There was an obvious absence of any role of pharmacists in the health care system for our studied population. Health care professionals are encouraged to review the medications prescribed for geriatric patients using updated safety guidelines to prevent the risks associated with potentially inappropriate medications.

Antimicrobial peptides for the treatment of pulmonary tuberculosis, allies or foes?

2018 ◽  
Vol 24 (10) ◽  
pp. 1138-1147
Author(s):  
Bruno Rivas-Santiago ◽  
Flor Torres-Juarez
Keyword(s):  
Pulmonary Tuberculosis ◽  
Antimicrobial Peptides ◽  
Experimental Models ◽  
New Drugs ◽  
World Health ◽  
Public Health Issue ◽  
Health Organization ◽  
Drug Resistant Strains

Tuberculosis is an ancient disease that has become a serious public health issue in recent years, although increasing incidence has been controlled, deaths caused by Mycobacterium tuberculosis have been accentuated due to the emerging of multi-drug resistant strains and the comorbidity with diabetes mellitus and HIV. This situation is threatening the goals of World Health Organization (WHO) to eradicate tuberculosis in 2035. WHO has called for the creation of new drugs as an alternative for the treatment of pulmonary tuberculosis, among the plausible molecules that can be used are the Antimicrobial Peptides (AMPs). These peptides have demonstrated remarkable efficacy to kill mycobacteria in vitro and in vivo in experimental models, nevertheless, these peptides not only have antimicrobial activity but also have a wide variety of functions such as angiogenesis, wound healing, immunomodulation and other well-described roles into the human physiology. Therapeutic strategies for tuberculosis using AMPs must be well thought prior to their clinical use; evaluating comorbidities, family history and risk factors to other diseases, since the wide function of AMPs, they could lead to collateral undesirable effects.

A Review of Statistical and Machine Learning Techniques for Microvascular Complications in Type 2 Diabetes

2020 ◽  
Vol 16 ◽  
Author(s):  
Nitigya Sambyal ◽  
Poonam Saini ◽  
Rupali Syal
Keyword(s):  
Machine Learning ◽  
Prediction Models ◽  
Clinical Medicine ◽  
Microvascular Complications ◽  
Descriptive Analysis ◽  
Machine Learning Techniques ◽  
World Health ◽  
Public Health Issue ◽  
Learning Techniques ◽  
Health Organization

Background and Introduction: Diabetes mellitus is a metabolic disorder that has emerged as a serious public health issue worldwide. According to the World Health Organization (WHO), without interventions, the number of diabetic incidences is expected to be at least 629 million by 2045. Uncontrolled diabetes gradually leads to progressive damage to eyes, heart, kidneys, blood vessels and nerves. Method: The paper presents a critical review of existing statistical and Artificial Intelligence (AI) based machine learning techniques with respect to DM complications namely retinopathy, neuropathy and nephropathy. The statistical and machine learning analytic techniques are used to structure the subsequent content review. Result: It has been inferred that statistical analysis can help only in inferential and descriptive analysis whereas, AI based machine learning models can even provide actionable prediction models for faster and accurate diagnose of complications associated with DM. Conclusion: The integration of AI based analytics techniques like machine learning and deep learning in clinical medicine will result in improved disease management through faster disease detection and cost reduction for disease treatment.

How India Fights with COVID-19 with Learning from Highly Affected Countries

2020 ◽  
Vol 15 ◽  
Author(s):  
Pooja Sharma ◽  
Karan Veer
Keyword(s):  
Risk Assessment ◽  
Gene Sequencing ◽  
Lessons Learned ◽  
World Health ◽  
Global Risk ◽  
The World ◽  
Global Risk Assessment ◽  
Health Organization ◽  
Very High ◽  
Breathing Problem

: It was 11 March 2020 when the World Health Organization (WHO) declared the name COVID-19 for coronavirus disease and also described it as a pandemic. Till that day 118,000 cases were confirmed of pneumonia with breathing problem throughout the world. At the start of New Year when COVID-19 came into knowledge a few days later, the gene sequencing of the virus was revealed. Today the number of confirmed cases is scary, i.e. 9,472,473 in the whole world and 484,236 deaths have been recorded by WHO till 26 June 2020. WHO's global risk assessment is very high [1]. The report is enlightening the lessons learned by India from the highly affected countries.

scholarly journals Disability, Frailty and Depression in the community-dwelling older adults with Osteosarcopenia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ki-Soo Park ◽  
Gyeong-Ye Lee ◽  
Young-Mi Seo ◽  
Sung-Hyo Seo ◽  
Jun-Il Yoo
Keyword(s):  
Older Adults ◽  
Short Form ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Community Dwelling ◽  
Normal Group ◽  
World Health ◽  
Common Disease ◽  
Using Data ◽  
Health Organization

Abstract Background The purpose of this study was to investigate the prevalence of osteosarcopenia in the over 60-year-old community and to evaluate whether osteosarcopenia is associated with disability, frailty and depression. Methods This study was performed using the baseline data of Namgaram-2, among the 1010 surveyed subjects, 885 study subjects who were 60 years or older and had all necessary tests performed were selected. The Kaigo-Yobo checklist (frailty), World Health Organization Disability Assessment Schedule (WHODAS) and Geriatric Depression Scale-Short Form-Korean (GDSSF-K) were used. The Asian Working Group for Sarcopenia (AWGS 2019) were applied in this study. Osteopenia was measured using data from dual energy X-ray absorptiometry (DEXA) and osteopenia was diagnosed when the T-score was less than − 1.0. The study subjects were divided into four groups: the normal group, in which both sarcopenia and osteopenia were undiagnosed, osteopenia only, sarcopenia only and the osteosarcopenia group, which was diagnosed with both sarcopenia and osteopenia. Results Of the 885 subjects over 60 years old evaluated, the normal group comprised 34.0%, the only osteopenia group 33.7%, the only sarcopenia group 13.1%, and the osteosarcopenia group 19.2%. WHODAS (17.5, 95% CI: 14.8-20.1), Kaigo-Yobo (3.0, 95% CI: 2.6-3.4), and GDSSF mean score (4.6, 95% CI: 3.9-5.4) were statistically significantly higher in the osteosarcopenia group compared the other groups. Partial eta squared (ηp2) of WHODAS (0.199) and Kaigo-Yobo (0.148) values ​​according to Osteosarcopenia were large, and GDSSF (0.096) was medium Conclusions Osteosarcopenia is a relatively common disease group in the older adults community that may cause deterioration of health outcomes. Therefore, when evaluating osteopenia or sarcopenia in the older adults, management of those in both disease groups should occur together.

scholarly journals Implementation of Remote Interventions in Older Adults: Lessons Learned During COVID-19 Isolation

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 950-950
Author(s):  
Jamie Rincker ◽  
Jessica Wallis ◽  
Angela Fruik ◽  
Alyssa King ◽  
Kenlyn Young ◽  
...  
Keyword(s):  
Older Adults ◽  
Weight Loss ◽  
Nutrition Education ◽  
Underserved Populations ◽  
Smart Phone ◽  
Dropout Rate ◽  
Lessons Learned ◽  
Drop Out ◽  
Electronic Submission ◽  
Weight Loss Interventions

Abstract Recommendations for older adults to socially isolate during the COVID-19 pandemic will have lasting impacts on body weight and physical activity. Due to the pandemic, two in-person RCT weight-loss interventions in obese older adults with prediabetes, Veterans Achieving Weight Loss and Optimizing Resilience-Using Protein (VALOR-UP, n=12) and the Egg-Supplemented Pre-Diabetes Intervention Trial (EGGSPDITE, n=7), were converted to remote formats and weekly nutrition (EGGSPDITE and VALOR-UP) and exercise (VALOR-UP only) classes were delivered using synchronous videoconference technology (Webex); classes were accessed via tablet/desktop/laptop or smart phone. Steps taken to transition participants to remote formats included technology training, implementation of staff tech-support, and delivery of nutrition education, tablets, scales, and exercise bands. The time to successfully transition participants was 1 week for early adopters (n=10) and up to 4 weeks for those with significant technology barriers (n=9); their difficulties included internet access, camera and microphone access and use, and electronic submission of weight and food records. Even with these challenges, in the first 3 months of remote delivery, participant dropout rate was low (10.5%, n=2), attendance was high (87.6% nutrition class (n=19); 76.4% exercise class (VALOR-UP, n=12)), and weight loss was successful (>2.5% loss (n=13); >5% loss (n=8)), showing that lifestyle interventions can be successfully adapted for remote delivery. Remote interventions also have potential for use in non-pandemic times to reach underserved populations who often have high drop-out rates due to caretaker roles, transportation limitations, and work schedules. These barriers were significantly reduced using a virtual intervention platform.

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